Jerry Ney, the President and CEO of Aldersgate Village, shows off one of several high-tech pieces of equipment Wednesday afternoon that his staff use to help people through physical therapy. This zero-gravity treadmill uses air pressure to relieve pain in the lower body while working out areas like knees, hips and ankles.

The zero-gravity treadmill at the Aldersgate Village Therapy Center uses air pressure to relieve pain in the lower body while working out areas like knees, hips and ankles. The center works with people who were recently hospitalized for surgery, stroke or injuries that affected their ability to live independently.

Jerry Ney, the President and CEO of Aldersgate Village, talks about a piece of equipment, Wednesday afternoon, that was designed by the Mayo Clinic and that his staff and physical therapy patients have access to in their therapy center.

Topeka nursing homes are adjusting to meet the needs of people who are only staying with them temporarily but may have significant health needs, and who want something different from typical long-term care.

Jerry Ney, president and CEO of Aldersgate Village, said the facility’s post-acute building, called the recovery center, serves people who were discharged from the hospital but who aren’t yet able to go home or to a permanent facility. Many of the patients have had joint replacements, strokes or injuries that affect their mobility.

The recovery center has 10 private rooms and is separate from the general nursing home population, with its own dining room, Ney said. Residents have their own bathrooms that are modified for easy use by people who use wheelchairs or aren’t steady on their feet, he said.

“Nobody wants to go to a nursing home,” he said. “So we’ve created an environment that’s completely different.”

Patients can use specialized equipment, such as a treadmill that uses air to take pressure off the lower body joints, and practice in rooms constructed to look like an ordinary kitchen and bathroom that they might need to navigate at home, Ney said.

Marsha Anderson, marketing director for Topeka Presbyterian Manor, said they have offered services for people leaving the hospital for years. In June, they opened a wing for the Post-Acute to Home (PATH) program for people who need rehabilitation, she said.

People who are only in a nursing home temporarily tend to like to be around people who are in a similar situation instead of sharing space with permanent residents, Anderson said. They have 16 private rooms with accessible bathrooms, a separate dining room and a therapy room with equipment like a virtual reality system that lets people practice movements in a game, she said.

“They feel very much like a nice hotel room,” she said.

Anderson said hospitals have been more cautious about discharging people before they might be ready because Medicare can penalize them for having too many patients readmitted.

“We’re seeing that trend swinging where the hospitals are being much more cautious about discharging people too soon,” she said.

Ney said Aldersgate is seeing an increase in patients who just left the hospital and need skilled nursing care, but who won’t necessarily become permanent residents. In the past, those people would have stayed in the hospital longer, but both Medicare and Medicaid are looking for the least expensive care option that meets patients’ needs, he said, and they have penalties for hospitals that aren’t able to discharge patients in the time calculated as necessary for their diagnosis.

At the same time, hospitals also can be penalized for high readmission rates, meaning it isn’t in their interest to recommend sending someone home if that person is likely to get sick again in the near future. That means they have an incentive to look for alternatives, such as nursing homes.

“The nursing homes have to be prepared to deal with people sicker and quicker,” Ney said. “The skilled nursing facility really is becoming a much more important partner to the hospitals.”

Debra Zehr, president and CEO of LeadingAge Kansas, a nonprofit that represents 160 nonprofit long-term care providers, most of which are nursing homes, said there has been a shift in care nationwide as Medicare and private insurers try to minimize the number of times people are hospitalized and how much time they spend there. Even before health care reform passed, Medicare was changing its reimbursement policy to reduce hospital stays among people who could go to a different setting for care, she said.

“There’s going to be a movement toward using money more efficiently,” she said.

People tend to enter a nursing home later in life and with more significant health issues than they did in the past, Zehr said. Many choose to go into assisted living when they can’t care for a home and need medical help, she said — though that option doesn’t always exist in rural parts of the state.

“I think the whole thing is shifting,” she said. “People don’t go to a nursing home unless they absolutely feel they need to.”

Caring for sicker patients means facilities have to hire more staff, and especially more skilled staff, such as registered nurses, Ney said. That puts a squeeze on finances because Medicare hasn’t adjusted its reimbursement rate for inflation in three years, he said.

The higher level of care needed creates a challenge for facilities, Ney said, but he believes nursing homes have a role in providing care people need while slowing the growth of spending on health care.

“It’s a little bit more challenging. It’s a little bit more interesting,” he said. “It’s a little bit more worthwhile.”

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If you value Medicare and Medicaid healthcare programs, now is the time to act to stop the Kansas Legislature and Governor Brownback from opting out of these important programs for Kansas seniors.

Unfortunately the Kansas Legislature passed the so-called “Health Care Compact” (HB 2553) that, if signed into law by Gov. Brownback, risks the health care, safety and oversight protections that Medicare provides, as well as the health and safety regulation of nursing facilities Medicaid provides.

Governor Brownback has not yet signed the bill. He is reviewing it now, and our hope is that after hearing from Kansans directly he will Veto HB 2553 and preserve Medicare for elder Kansans and Medicaid for elders in nursing facilities.

So our next step is to contact Governor Brownback.

Whether you email his office or call it, please ask that Governor Brownback protect the federal Medicare program and veto the “Health Care Compact” HB 2553.

Elder Kansans depend on Medicare. Without it, their health and safety could be jeopardized with fewer choices, fewer benefits and less access to the long-term services and supports they need.

Medicare made a promise to our elders and it works. It should not be abandoned on a whim, risking the health care and security of more than 448,000 Kansans who count on Medicare and the 10,000 frail elders who rely on Medicaid for nursing facility care.

Elder care should not be a pawn in a political game. This attempt to abandon the federal Medicare and Medicaid programs allows Kansas to break the Medicare promise.

Call on Gov. Brownback to do right by Kansas elders. Urge him to veto HB 2553, the Health Care Compact bill.

When you need nursing care or medical care, you deserve better than being shunted to a nursing home that is allowed to hire caregivers who often only have GED degrees, even though they are universally nice and kind people, rather than staffing with caregivers who have actual nursing degrees. And why? To save money, of course, because the controlling political party in Kansas, the GOP, will not accept government Medicaid money out of a pure political fight against Obama and a blind ideological belief that money raised by taxation is automatically something to be rejected, even if it harms patients.

Party, as you say in Kansas has no control over whom these nursing homes hire. To say that any party will not accept Medicaid is a direct slam to the party itself with a lack of knowledge regarding the subject at hand.

You don't understand. States like Kansas who rejected the additional Medicaid money because they wanted the ACA to fail, have left hospitals without the funds needed to keep patients in hospitals past the acute phase. They cannot afford it, because hospitals are staffed with nurses with degrees in nursing, who are trained to recognize situations and manage them in patients who are still in need of actual nursing care in an inpatient setting. Nursing homes have never been required to staff with degree or diploma nurses. They can hire people with GED's and train them. They are nearly always kind, compassionate, and well trained and deserve our respect and admiration. But they are not nurses with degrees beyond college. This has nothing to do with political parties. It has always been that way. But patients just past the acute phase are still often in great danger if not watched by people with actual nursing degrees.

The refusal of Kansas legislators to accept the Medicaid money under ACA has left hospitals with no choice. The hospitals must discharge them. At some point, if you have a bad injury or illness, and your insurance policy does not cover extended care well, you will be in the same situation and may have no choice other than nursing home care. And in the middle of the night, the staff there looking in on you may not recognize that you are showering your lungs with microemboli causing respiratory failure or right heart failure, and may think you are just anxious or unable to sleep, because they are not nurses. And you might die as a result. I hope that doesn't happen to you. Do you understand?